mHealth delivered narrative intervention to increase cervical cancer screening among Malawian Women living with HIV

移动医疗提供叙事干预，以增加马拉维艾滋病毒感染者的宫颈癌筛查

• 批准号: 9979152
• 负责人: Haeok Lee
• 金额: $ 21.53万
• 依托单位: UNIVERSITY OF MASSACHUSETTS BOSTON
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-23 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9979152
• 关键词: AIDS/HIV problem; Acetic Acids; Active Learning; Acute; Address; Adherence; African; Area; Awareness; Behavior; Car Phone; Caring; Cellular Phone; Cervical Cancer Screening; Charge; Communities; Computer Assisted; Country; Data; Data Collection; Development; Diagnosis; Diffusion; Educational process of instructing; Effectiveness; Effectiveness of Interventions; Electricity; Emotional; Enrollment; Ethnography; Evaluation; Evidence based intervention; Foundations; HIV; HIV Infections; Health; Health Personnel; Health Professional; Health behavior; Health behavior change; Health education; Healthcare; Home environment; Human Papillomavirus; Infection; Intervention; Interview; Knowledge; Learning; Lesion; Low Literacy Population; Malawi; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Manuals; Methods; Morbidity - disease rate; Outcome; Outcomes Research; Penetration; Personal Satisfaction; Phase; Population; Prevention; Procedures; Process; Public Health Informatics; Quality of Care; Randomized; Randomized Clinical Trials; Research; Resources; Rural; Screening for cancer; Self Efficacy; Self Management; Services; Social support; Standardization; Support Groups; System; Tablets; Testing; Translating; Visual; Woman; Work; arm; attentional control; base; behavior change; cervical cancer prevention; clinical practice; cohesion; control trial; cost; cost effective; cost effectiveness; disorder prevention; effective intervention; effectiveness testing; electronic data; evidence base; experimental study; global health; handheld mobile device; health belief; health care settings; health training; implementation strategy; improved; innovation; interactive multimedia; intervention effect; literacy; low income country; mHealth; member; mortality; novel; operation; pedagogy; premalignant; prevent; programs; prospective; recruit; rural area; rural residence; screening; social media; theories; uptake; wireless fidelity

Cervical cancer (CC) is the leading cause of morbidity and mortality among women living with HIV (WLWHIV) in Malawi. Screening and treating women with precancerous lesions has been shown to be highly effective in the prevention of CC but the availability of CC screening does not automatically translate into their utilization among WLWHIV. . Prevention of HPV-related cervical cancers in WLWHIV, particularly in the context of resource-constrained settings where prevention-oriented services are either lacking or the health beliefs of the population are oriented toward the treatment of acute illness is problematic. Culturally tailored and evidence- based interventions to increase screening uptake is needed. Storytelling narrative interventions hold particular promise as a means to engage vulnerable (often low-literacy) populations in positive health behaviors including cancer screening. In addition, narrative interventions such as storytelling made available through social media holds the promise of engaging WLWHIV in more active participation in health prevention/self-management. This study addresses the following specific aims: Phase I: Developmental Phase: Develop intervention Specific Aim 1: We will develop an interactive, multi-media intervention based on authentic stories from Malawian WLWHIV, local community leaders, and Malawian health care providers that encompasses targeted health messages that are consistent with the situation-specific theory and the desired behavior (CC screening). Phase II: Implement Phase: Conduct a pilot randomized clinical trial (RCT) Specific Aim 2: We will conduct a pilot RCT with three groups (Arm 1: Storytelling Narrative+mHealth; Arm 2: mHealth; and Arm 3: Attention control; N=180) to assess the feasibility, acceptability, and preliminary effectiveness of a narrative intervention delivered by mHealth (tablets) among WLWHIV. We will select 15 established HIV support groups within the rural areas of the Lilongwe district of Malawi and randomly assign the group to an intervention strategy (Arms 1, 2, or 3). Within each selected HIV support group, 12 WLWHIV who are willing to participate in the study will be prospectively enrolled. The findings and experiential learning gained from this study will lay the foundation for a larger trial that can test the effectiveness of the intervention. Although the proposed implementation strategy is evidence-informed and promising, its use is novel in HIV support group settings and in mHealth delivery. There needs to be feasibility testing in the mHealth setting prior to a larger-scale evaluation of its effectiveness in a low-income country. This project is innovative in that it attempts to integrate CC screening into the HIV support group system already in place in Malawi and develops a locally tailored novel narrative intervention that is culturally and literacy sensitive. The proposed study is significant because of its potential to improve CC prevention by equipping Malawian WLWHIV with self-confidence with cultural and evidence-based strategies to increase CC screening uptakes.

宫颈癌 (CC) 是艾滋病毒感染女性 (WLWHIV) 发病和死亡的主要原因 在马拉维。筛查和治疗患有癌前病变的女性已被证明在以下方面非常有效： 预防 CC，但 CC 筛查的可用性不会自动转化为它们的利用 WLWHIV 中。 。预防 WLWHIV 中的 HPV 相关宫颈癌，特别是在以下情况下 资源有限的环境，要么缺乏以预防为导向的服务，要么缺乏人们的健康信念 人口对急性疾病治疗的导向是有问题的。文化定制和证据- 需要采取基础干预措施来提高筛查率。讲故事的叙事干预具有特殊性 承诺作为让弱势群体（通常识字率低）参与积极健康行为的一种手段，包括 癌症筛查。此外，通过社交媒体提供讲故事等叙事干预措施 承诺让 WLWHIV 更积极地参与健康预防/自我管理。 本研究旨在实现以下具体目标： 第一阶段：发展阶段：制定干预措施 具体目标 1：我们将根据真实故事开发交互式多媒体干预措施 马拉维 WLWHIV、当地社区领袖和马拉维卫生保健提供者，其中包括有针对性的 与特定情况理论和期望行为一致的健康信息（CC 筛查）。 第二阶段：实施阶段：进行试点随机临床试验（RCT） 具体目标 2：我们将针对三个小组进行试点随机对照试验（第 1 组：讲故事 + 移动健康；第 2 组： 移动医疗；第 3 臂：注意力控制； N=180) 评估可行性、可接受性和初步 mHealth（平板电脑）在 WLWHIV 中提供的叙事干预的有效性。我们将选出15个 在马拉维利隆圭地区的农村地区建立了艾滋病毒支持小组，并随机分配 小组采取干预策略（第 1、2 或 3 组）。在每个选定的 HIV 支持小组中，12 名 WLWHIV 愿意参加该研究的人将被前瞻性地纳入。研究结果和体验式学习 这项研究的成果将为更大规模的试验奠定基础，以测试干预措施的有效性。 尽管拟议的实施策略是有证据支持且有希望的，但其在艾滋病毒中的应用是新颖的 支持小组设置和移动医疗交付。移动医疗环境需要进行可行性测试 在对其在低收入国家的有效性进行更大规模的评估之前。这个项目的创新之处在于 它试图将 CC 筛查纳入马拉维已有的艾滋病毒支持小组系统， 开发一种针对文化和识字能力敏感的本地定制小说叙事干预。拟议的 该研究具有重要意义，因为它有可能通过为马拉维 WLWHIV 配备以下药物来改善 CC 预防 对提高 CC 筛查采用率的文化和循证策略的信心。